衰弱作为危重症老年创伤患者的预后因素。
Frailty as a prognostic factor for the critically ill older adult trauma patients.
机构信息
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States.
The University of Arizona College of Medicine, Tucson, United States.
出版信息
Am J Surg. 2019 Sep;218(3):484-489. doi: 10.1016/j.amjsurg.2019.01.035. Epub 2019 Feb 22.
BACKGROUND
Frailty is highly prevalent in the elderly and confers high risk for adverse outcomes. We aimed to assess the impact of frailty on critically ill older adult trauma patients.
METHODS
We analyzed the ACS-TQIP(2010-2014) including all critically-ill trauma patients ≥65y. The modified frailty index (mFI) was calculated. Following stratified into frail and non-frail, propensity score matching was performed. Our primary outcome measure was in-hospital complications. Secondary outcome measures included mortality and discharge disposition.
RESULTS
We identified 88,629 patients, of which 34,854 patients (frail: 17,427, non-frail: 17,427) were matched. Overall 14% died. Frail patients had higher rates of complications (34% vs. 18%, p < 0.001), mortality (18.1% vs. 9.7%, p < 0.001), and were more likely to be discharged to rehab/SNF (58.7% vs. 21.2% p < 0.001) compared to non-frail patients.
CONCLUSION
critically-ill frail patients are more likely to have higher morbidity and mortality. Frailty can be used as an objective measure to identify high-risk patients.
背景
衰弱在老年人中非常普遍，并带来不良后果的高风险。我们旨在评估衰弱对重症老年创伤患者的影响。
方法
我们分析了 ACS-TQIP（2010-2014），其中包括所有≥65 岁的重症创伤患者。计算了改良衰弱指数（mFI）。然后按照衰弱和非衰弱分层，进行倾向评分匹配。我们的主要结局指标是院内并发症。次要结局指标包括死亡率和出院去向。
结果
我们确定了 88629 名患者，其中 34854 名患者（衰弱：17427 名，非衰弱：17427 名）进行了匹配。总体死亡率为 14%。衰弱患者的并发症发生率（34% vs. 18%，p<0.001）、死亡率（18.1% vs. 9.7%，p<0.001）和更有可能被送往康复/护理机构（58.7% vs. 21.2%，p<0.001）更高。
结论
重症衰弱患者更有可能出现更高的发病率和死亡率。衰弱可以作为识别高危患者的客观指标。
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